|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$11,315.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,011.41 |
| Max. Negotiated Rate |
$10,749.25 |
| Rate for Payer: Aetna of VT Commercial |
$10,749.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10,137.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5,011.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10,137.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6,811.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,617.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,165.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5,091.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,995.42
|
| Rate for Payer: Cash Price |
$5,657.50
|
| Rate for Payer: Cigna Commercial |
$9,052.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9,052.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9,052.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$5,091.75
|
| Rate for Payer: Multiplan Commercial |
$10,522.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,617.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5,091.75
|
| Rate for Payer: United Healthcare Commercial |
$10,749.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,091.75
|
| Rate for Payer: United Healthcare VA CCN |
$5,091.75
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$10,874.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5102420001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8,047.85 |
| Max. Negotiated Rate |
$10,330.30 |
| Rate for Payer: Aetna of VT Commercial |
$10,330.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,047.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,047.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,242.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,134.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,699.20
|
| Rate for Payer: Cash Price |
$5,437.00
|
| Rate for Payer: Cigna Commercial |
$8,699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,699.20
|
| Rate for Payer: Multiplan Commercial |
$10,112.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,242.90
|
| Rate for Payer: United Healthcare Commercial |
$10,330.30
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
9822090001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$942.89 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,210.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$942.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$942.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,070.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,019.20
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cigna Commercial |
$1,019.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,019.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,019.20
|
| Rate for Payer: Multiplan Commercial |
$1,184.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,082.90
|
| Rate for Payer: United Healthcare Commercial |
$1,210.30
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
9822090001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$167.09 |
| Max. Negotiated Rate |
$1,197.56 |
| Rate for Payer: Aetna of VT Commercial |
$1,197.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,141.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,141.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$233.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$709.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$192.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.21
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cigna Commercial |
$317.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$586.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$586.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.17
|
| Rate for Payer: Multiplan Commercial |
$1,184.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.09
|
| Rate for Payer: United Healthcare Commercial |
$257.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.09
|
| Rate for Payer: United Healthcare VA CCN |
$167.09
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
9822090001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$564.25 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,210.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,141.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$564.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,141.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$766.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,031.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,012.83
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cigna Commercial |
$1,019.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,019.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,019.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$573.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,082.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$573.30
|
| Rate for Payer: United Healthcare Commercial |
$1,210.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$573.30
|
| Rate for Payer: United Healthcare VA CCN |
$573.30
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
IP
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,139.25 |
| Max. Negotiated Rate |
$6,596.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,139.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,902.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,832.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,555.20
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,555.20
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,902.40
|
| Rate for Payer: United Healthcare Commercial |
$6,596.80
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$964.35 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,237.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$964.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$964.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,094.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,042.40
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,042.40
|
| Rate for Payer: Multiplan Commercial |
$1,211.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,107.55
|
| Rate for Payer: United Healthcare Commercial |
$1,237.85
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
IP
|
$5,641.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
5101912001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,174.90 |
| Max. Negotiated Rate |
$5,358.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,358.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,174.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,794.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,738.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,512.80
|
| Rate for Payer: Cash Price |
$2,820.50
|
| Rate for Payer: Cigna Commercial |
$4,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,512.80
|
| Rate for Payer: Multiplan Commercial |
$5,246.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,794.85
|
| Rate for Payer: United Healthcare Commercial |
$5,358.95
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
OP
|
$5,641.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
5101912001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,498.40 |
| Max. Negotiated Rate |
$5,358.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,358.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,053.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,498.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,053.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,395.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,794.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,569.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,538.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,484.60
|
| Rate for Payer: Cash Price |
$2,820.50
|
| Rate for Payer: Cigna Commercial |
$4,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,512.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,538.45
|
| Rate for Payer: Multiplan Commercial |
$5,246.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,794.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,538.45
|
| Rate for Payer: United Healthcare Commercial |
$5,358.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,538.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,538.45
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
IP
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9821912001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$5,139.25 |
| Max. Negotiated Rate |
$6,596.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,139.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,902.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,832.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,555.20
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,555.20
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,902.40
|
| Rate for Payer: United Healthcare Commercial |
$6,596.80
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
OP
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,075.50 |
| Max. Negotiated Rate |
$6,596.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,075.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,180.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,902.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,624.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,124.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,520.48
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,555.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,124.80
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,902.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,124.80
|
| Rate for Payer: United Healthcare Commercial |
$6,596.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,124.80
|
| Rate for Payer: United Healthcare VA CCN |
$3,124.80
|
|
|
REMOVAL OF BREAST LESION
|
Professional
|
Both
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$388.76 |
| Max. Negotiated Rate |
$6,527.36 |
| Rate for Payer: Aetna of VT Commercial |
$6,527.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.49
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$709.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$811.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$811.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare Commercial |
$598.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare VA CCN |
$388.76
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
OP
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9821912001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,075.50 |
| Max. Negotiated Rate |
$6,596.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,075.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,180.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,902.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,624.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,124.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,520.48
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,555.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,124.80
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,902.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,124.80
|
| Rate for Payer: United Healthcare Commercial |
$6,596.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,124.80
|
| Rate for Payer: United Healthcare VA CCN |
$3,124.80
|
|
|
REMOVAL OF BREAST LESION
|
Professional
|
Both
|
$5,641.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
5101912001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$388.76 |
| Max. Negotiated Rate |
$5,302.54 |
| Rate for Payer: Aetna of VT Commercial |
$5,302.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,053.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,053.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.49
|
| Rate for Payer: Cash Price |
$2,820.50
|
| Rate for Payer: Cash Price |
$2,820.50
|
| Rate for Payer: Cigna Commercial |
$709.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$811.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$811.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$5,246.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare Commercial |
$598.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare VA CCN |
$388.76
|
|
|
REMOVAL OF BREAST LESION
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$388.76 |
| Max. Negotiated Rate |
$1,224.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.49
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$709.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$811.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$811.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,211.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare Commercial |
$598.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare VA CCN |
$388.76
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9601912002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$577.10 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,237.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$577.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$784.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,055.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$586.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,035.88
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,042.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$586.35
|
| Rate for Payer: Multiplan Commercial |
$1,211.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,107.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$586.35
|
| Rate for Payer: United Healthcare Commercial |
$1,237.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$586.35
|
| Rate for Payer: United Healthcare VA CCN |
$586.35
|
|
|
REMOVAL OF BREAST LESION
|
Professional
|
Both
|
$6,944.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
9821912001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$388.76 |
| Max. Negotiated Rate |
$6,527.36 |
| Rate for Payer: Aetna of VT Commercial |
$6,527.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,221.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.49
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cash Price |
$3,472.00
|
| Rate for Payer: Cigna Commercial |
$709.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$811.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$811.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$6,457.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare Commercial |
$598.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.76
|
| Rate for Payer: United Healthcare VA CCN |
$388.76
|
|
|
REMOVAL OF COLON
|
Facility
|
IP
|
$3,567.00
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
9824416001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,639.94 |
| Max. Negotiated Rate |
$3,388.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,388.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,639.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,639.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,031.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,996.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,853.60
|
| Rate for Payer: Cash Price |
$1,783.50
|
| Rate for Payer: Cigna Commercial |
$2,853.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,853.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,853.60
|
| Rate for Payer: Multiplan Commercial |
$3,317.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,031.95
|
| Rate for Payer: United Healthcare Commercial |
$3,388.65
|
|
|
REMOVAL OF COLON
|
Professional
|
Both
|
$5,483.00
|
|
|
Service Code
|
CPT 44150
|
| Hospital Charge Code |
9824415001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,687.36 |
| Max. Negotiated Rate |
$5,154.02 |
| Rate for Payer: Aetna of VT Commercial |
$5,154.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,912.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,737.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,912.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,362.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,549.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,549.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,940.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,549.93
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cigna Commercial |
$3,091.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,855.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,855.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,687.36
|
| Rate for Payer: Multiplan Commercial |
$5,099.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,396.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,687.36
|
| Rate for Payer: United Healthcare Commercial |
$2,595.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,687.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,687.36
|
|
|
REMOVAL OF COLON
|
Facility
|
OP
|
$3,567.00
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
9824416001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,579.82 |
| Max. Negotiated Rate |
$3,388.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,388.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,195.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,579.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,195.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,147.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,031.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,889.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,605.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,835.76
|
| Rate for Payer: Cash Price |
$1,783.50
|
| Rate for Payer: Cigna Commercial |
$2,853.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,853.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,853.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,605.15
|
| Rate for Payer: Multiplan Commercial |
$3,317.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,031.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,605.15
|
| Rate for Payer: United Healthcare Commercial |
$3,388.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,605.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,605.15
|
|
|
REMOVAL OF COLON
|
Professional
|
Both
|
$3,567.00
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
9824416001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,131.46 |
| Max. Negotiated Rate |
$3,352.98 |
| Rate for Payer: Aetna of VT Commercial |
$3,352.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,195.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,165.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,195.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,584.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,844.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,844.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,301.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,844.31
|
| Rate for Payer: Cash Price |
$1,783.50
|
| Rate for Payer: Cash Price |
$1,783.50
|
| Rate for Payer: Cigna Commercial |
$2,069.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,921.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,921.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,131.46
|
| Rate for Payer: Multiplan Commercial |
$3,317.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,606.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,131.46
|
| Rate for Payer: United Healthcare Commercial |
$1,740.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,131.46
|
| Rate for Payer: United Healthcare VA CCN |
$1,131.46
|
|
|
REMOVAL OF COLON
|
Facility
|
OP
|
$5,483.00
|
|
|
Service Code
|
CPT 44150
|
| Hospital Charge Code |
9824415001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,428.42 |
| Max. Negotiated Rate |
$5,208.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,208.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,912.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,428.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,912.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,300.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,660.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,467.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,358.98
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cigna Commercial |
$4,386.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,386.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,386.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,467.35
|
| Rate for Payer: Multiplan Commercial |
$5,099.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,660.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,467.35
|
| Rate for Payer: United Healthcare Commercial |
$5,208.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,467.35
|
| Rate for Payer: United Healthcare VA CCN |
$2,467.35
|
|
|
REMOVAL OF COLON
|
Facility
|
IP
|
$5,483.00
|
|
|
Service Code
|
CPT 44150
|
| Hospital Charge Code |
9824415001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$4,057.97 |
| Max. Negotiated Rate |
$5,208.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,208.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,057.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,057.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,660.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,605.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,386.40
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cigna Commercial |
$4,386.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,386.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,386.40
|
| Rate for Payer: Multiplan Commercial |
$5,099.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,660.55
|
| Rate for Payer: United Healthcare Commercial |
$5,208.85
|
|
|
REMOVAL OF FALLOPIAN TUBE
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
9825870001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$743.68 |
| Max. Negotiated Rate |
$1,887.52 |
| Rate for Payer: Aetna of VT Commercial |
$1,887.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,798.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,798.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,041.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,248.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,248.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$855.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.76
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,310.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,245.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,245.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$743.69
|
| Rate for Payer: Multiplan Commercial |
$1,867.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,056.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$743.68
|
| Rate for Payer: United Healthcare Commercial |
$1,144.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$743.68
|
| Rate for Payer: United Healthcare VA CCN |
$743.68
|
|
|
REMOVAL OF FALLOPIAN TUBE
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
9825870001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,486.12 |
| Max. Negotiated Rate |
$1,907.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,907.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,486.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,486.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,706.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,686.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,606.40
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,606.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,606.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,606.40
|
| Rate for Payer: Multiplan Commercial |
$1,867.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,706.80
|
| Rate for Payer: United Healthcare Commercial |
$1,907.60
|
|
